Trump Says He Will Focus On Opioid Law Enforcement, Not Treatment

On Jan. 10, President Trump signed into law the bipartisan Interdict Act, to give federal agents more tools to curtail opioid trafficking. But, after declaring the opioid crisis a public health emergency last fall, Trump has been slow to request money for treatment, critics note.

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Originally published on February 9, 2018 6:00 pm

More than three months after President Trump declared the nation's opioid crisis a public health emergency, activists and health care providers say they're still waiting for some other action.

The Trump administration quietly renewed the declaration recently. But it has given no signs it's developing a comprehensive strategy to address an epidemic that claims more than 115 lives every day. The president now says that to combat opioids, he's focused on enforcement, not treatment.

Trump spent just over a minute of his 80-minute State of the Union address talking about opioids. In a speech this week in Cincinnati, he had a few more comments. The opioid epidemic, he said, "has never been worse. People form blue ribbon committees. They do everything they can. And frankly, I have a different take on it. My take is you have to get really, really tough, really mean with the drug pushers and the drug dealers."

The president's mention of "blue ribbon committees" sounds like a slam on one he convened last year, chaired by former New Jersey Gov. Chris Christie — the President's Commission on Combating Drug Addiction and the Opioid Crisis. The commission issued more than 50 recommendations. The administration has so far followed up on just a few of those recommendations.

Some officials and care providers who work on the frontlines of the opioid crisis, however, are scathing about what they see as a lack of action from the White House. Former Congressman Patrick Kennedy, who served on the White House opioid commission, says he's "incredulous" that, after declaring a public health emergency in October, the president still hasn't requested any money from Congress to combat the epidemic.

"I mean this is just a mental health crisis of the first order," Kennedy says, "and this administration has done nothing."

Here's what the administration has done so far:

President Trump declared a public health emergency in October to deal with the opioid epidemic. The declaration brought no new money to fund the federal response.

In November, President Trump announced he's donating his third-quarter salary — about $100,000 — to help the Department of Health and Human Services fight opioids.

The Centers for Medicare and Medicaid Services announced a policy change in November that allows states to apply for waivers allowing them to use Medicaid to pay for residential drug treatment at facilities that have more than 16 beds. Some states are already taking advantage of that policy change.

President Trump signed the Interdict Act in January giving federal agents additional tools for detecting fentanyl and other synthetic opioids at the border.

Also this month, Attorney General Jeff Sessions announced an operation using medical data to crack down on pharmacies and doctors that dispense suspicious amounts of opioids.

Here are things critics point out the administration hasn't done:

There is still no head of the Office of National Drug Control Policy. In October, Trump's nominee to the position, Rep. Tom Marino, R-Pa., withdrew his name after reports linked him with a bill that limited the DEA's ability to investigate abuses by opioid manufacturers and distributors.

President Trump still hasn't nominated anyone to head the Drug Enforcement Agency.

The administration hasn't asked Congress for any new funding to address the opioid epidemic.

Roughly 64,000 people died from drug overdoses in 2016, and data from the CDC indicates deaths are rising. Kennedy says what's needed is a coordinated federal response similar to the one in the mid-1990s — when the U.S. spent $24 billion a year to address the HIV/AIDS crisis.

"We're talking about a major league crisis and they're taking credit for little things, while the whole country is burning down," Kennedy says.

Instead of a big boost in funding, the Trump administration is focused, in many cases, on cutting spending.

In the 2018 budget, the president recommended cutting the Office of National Drug Control Policy budget by 95 percent, and may do so again this year.

"It's very hard to make sense of," says Keith Humphreys, a professor of psychiatry at Stanford and former policy adviser to the drug czar's office in the Obama administration. "I mean, it's like closing a fire station in the middle of a wildfire."

A law signed by President Barack Obama that designated a billion dollars to help states combat opioids runs out of money this year. Humphreys has seen no sign President Trump intends to ask Congress to renew that funding.

"The 2018 budget had a $400 million cut to the Substance Abuse and Mental Health Services Administration, which is the lead agency that funds treatment in the United States," Humphreys says. "So, the administration's impulse seems to be not to spend more — in fact to spend less."

The White House is preparing to act on one of the recommendations of its opioid commission—that it launch a campaign to educate the public, especially young people, on the dangers of opioids. The campaign is being developed not by the Office of National Drug Control Policy, but by a team in the White House led by Kellyanne Conway.

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MARY LOUISE KELLY, HOST:

The opioid crisis in this country claims more than 115 lives every day. President Trump says the solution to this epidemic lies in tougher enforcement.

More than three months after the president declared opioid abuse a public health emergency, activists and health care providers have been waiting for some other action. But the White House has not given any signals that a comprehensive strategy is coming, as NPR's Greg Allen reports.

GREG ALLEN, BYLINE: President Trump spent just over a minute of his 80-minute State of the Union address talking about opioids. He said the administration is committed to helping get treatment to those who need it.

But in a speech this week in Cincinnati, he said he believes the key to halting the epidemic is stricter law enforcement.

(SOUNDBITE OF ARCHIVED RECORDING)

PRESIDENT DONALD TRUMP: People form blue ribbon committees. They do everything they can. And frankly, I have a different take on it. My take is you have to get really, really tough - really mean with the drug pushers and the drug dealers. We could do all the blue ribbon committees we want.

ALLEN: The president's mention of a blue ribbon committee sounds like a slam on one Trump himself convened last year, chaired by former New Jersey Governor Chris Christie. The White House opioid commission issued more than 50 recommendations. The administration has so far followed up on just a few of them. A policy change announced in October, for example, allows states to use Medicaid to pay for residential drug treatment at facilities with more than 16 beds.

Most of the actions taken by the Trump administration on opioids, however, have focused on enforcement. In Tampa today, Attorney General Jeff Sessions touted the success of an effort that uses medical data to crack down on pharmacies and doctors that dispense suspicious amounts of opioids.

(SOUNDBITE OF ARCHIVED RECORDING)

JEFF SESSIONS: We are not going to stand by and let more of our friends, families and members get addicted, destroyed or die from drug overdose.

ALLEN: Advocates and providers who work on the front lines of the opioid crisis, however, are scathing about what they see as a lack of action from the White House.

Former Congressman Patrick Kennedy, who served in the White House opioid commission, says he's incredulous that after declaring a public health emergency in October, the president still hasn't requested any money from Congress to combat the epidemic.

PATRICK KENNEDY: I mean, this is just a mental health crisis of the first order, and this administration has done nothing.

ALLEN: What's missing, Kennedy says, is a coordinated federal response similar to that in the mid-'90s when the U.S. spent $24 billion a year to address the HIV/AIDS crisis.

KENNEDY: We're talking about a major league crisis, and they're taking credit for little things while the whole country's burning down.

ALLEN: Sixty-four thousand people died from drug overdoses in 2016, and data from the CDC indicates deaths are rising. But more than a year after taking office, President Trump still has not filled a position vital to the administration's opioid response - the head of the Office of National Drug Control Policy - the drug czar. In last year's budget, Trump recommended cutting the office's budget by 95 percent and may do so again this year.

KENNEDY: It's very hard to make sense of. I mean, it's like closing the fire station in the middle of a wildfire.

ALLEN: Keith Humphreys is a professor of psychiatry at Stanford and former policy adviser to the drug czar's office in the Obama administration. A law signed by President Obama that designated a billion dollars to help the states combat opioids runs out of money this year. Humphreys has seen no sign President Trump intends to ask Congress to renew that funding.

KEITH HUMPHREYS: The 2018 budget had a $400 million cut to the substance abuse and mental health services administration, which is the lead agency that funds treatment in the United States. So the administration's impulse seems to be not to spend more - in fact, to spend less.

ALLEN: The White House is preparing to act on one of the recommendations of its opioid commission - that it launch a campaign to educate the public, especially young people, on the dangers of opioids. The campaign is being developed not by the Office of National Drug Control Policy but by a team in the White House led by Kellyanne Conway. Greg Allen, NPR News. Transcript provided by NPR, Copyright NPR.